ICU Survivorship—The Relationship of Delirium, Sedation, Dementia, and Acquired Weakness
Open accessAbstract
The advent of modern critical care medicine has revolutionized care of the critically ill patient in the last 50 years. The Society of Critical Care Medicine (was formed in recognition of the challenges and need for specialized treatment for these fragile patients. As the specialty has grown, it has achieved impressive scientific advances that have reduced mortality and saved lives. With those advances, however, came growing recognition that the burden of critical illness did not end at the doorstep of the hospital. Delirium, once thought to be a mere by-product of critical illness, was found to be an independent predictor of mortality, prolonged mechanical ventilation, and long-lasting cognitive impairment. Similarly, deep sedation and immobility, so often used to keep patients “comfortable” and to facilitate mechanical ventilation and recovery, worsen mortality and lead to the development of ICU-acquired weakness. The realization that these outcomes are inextricably linked to one another and how we manage our patients has helped us recognize the need for culture change. We, as a specialty, now understand that although celebrating the successes of survival, we now also have a duty to focus on those who survive their diseases. Led by initiatives such as the ICU Liberation Campaign of the Society of Critical Care Medicine, the natural progression of the field is now focused on getting patients back to their homes and lives unencumbered by disability and impairment. Much work remains to be done, but the futures of our most critically ill patients will continue to benefit if we leverage and build on the history of our first 50 years.
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Experiencing delirium, a sudden and transient state of confusion common in hospitalized older adults, has been linked to long-term cognitive decline and dementia.
“Furthermore, experiencing delirium — a sudden and transient state of confusion common in hospitalized older adults — has been linked to long‐term cognitive decline and dementia.”
From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [228]
The Delirium section links delirium duration in ICU patients to acquired dementia lasting years after discharge, and the Acquired Dementia section identifies delirium duration as a risk factor for cognitive impairment. The paper describes delirium as acute and fluctuating, but its evidence concerns critically ill ICU patients; it does not establish that delirium is common among hospitalized older adults generally. (LLM, conf=0.85)
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Flagged first, then by citations
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- [73]Dangayach NS, Griffiths SA, Feng R, Keough M,: Resilience, Cognitive Reserve And Brain Reserve In Neurocritical Care: A Prospective Cohort Study. American journal of respiratory and critical care medicine 2017; 195
Cited by
Sorted by citations
2024 Alzheimer's disease facts and figures
(2024) · Alzheimer's & Dementia · doi:10.1002/alz.13809 · Cited by 2,536 · see citing works
- Authors
- Mart, M. F., Pun, B. T., Pandharipande, P., Jackson, J. C., & Ely, E. W.
- Affiliations
- Vanderbilt University Medical Center (US)
- Vanderbilt University (US)
- Venue
- Critical Care Medicine
- Published
- 2021-06-11
- Volume
- 49
- Issue
- 8
- Pages
- 1227-1240
- ISSN
- 0090-3493 (ISSN-L)
- PMC
- PMC8282752
- OpenAlex
- W3171249590
- Cited by
- 67
- References
- 102
- Citations by year
- 2026: 11 · 2025: 16 · 2024: 15 · 2023: 10 · 2022: 11 · 2021: 4
- FWCI
- 7.14
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Critical Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Aging (K76AG054864, R01AG058639)
- National Heart, Lung, and Blood Institute (R01HL111111, T32HL087738)
- National Institute of General Medical Sciences (R01GM120484)
- Topics
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Health Sciences › Health Professions › Radiological and Ultrasound Technology › Family and Patient Care in Intensive Care Units
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Keywords
- delirium, deep sedation, ICU-acquired weakness, dementia, immobility, prolonged mechanical ventilation, cognitive impairment, critical illness outcomes
- MeSH terms
- Frailty, Survivorship, Asthenia, Critical Care, Delirium, Dementia, Humans, Iatrogenic Disease, Intensive Care Units, Neuromuscular Diseases, Risk Factors, Critical Illness
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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